AN EVALUATION OF PRESENT-DAY METHODS OF DEALING WITH CONGENITAL DISLOCATION OF THE HIP

1. Predislocation and dislocation in infants, discovered by examination soon after birth, may be cured in a high percentage of cases by the abduction method of treatment.

2. After the beginning of the walking period of life, bloodless reduction by gentle manipulation should be tried in all favorable and border-line cases.

3. In many cases the dislocation appears clinically to be reduced by the manipulation, but in subsequent months and years it is discovered that subluxation or luxation has occurred or that serious structural abnormalities cause pain and disability of the hip. With the aid of the rules laid down by the author, it is possible in many cases to determine soon after the bloodless manipulation whether or not the hip may be expected to become normal both in structure and in function.

4. If manipulation is unsuccessful, open operation should be performed.

5. At every open reduction an attempt should be made to correct the obliquity and the shallowness of the acetabulum if these conditions are present, as they very frequently are.

6. Palliative operations should be performed in cases of irreducible dislocation to eliminate or reduce as much as possible the symptoms of pain and disability or to prevent their development. In such operations, no attempt is made to restore the normal anatomy of the hip.

7. The osteotomies of Lorenz and Schanz are undoubtedly useful in selected cases.

8. The reconstruction of an acetabulum, or the "shelf" operation, if properly performed, has proved to be a very valuable procedure in almost all cases.

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